Dietary consideration for heart disease

Sodium content of foods

Certainly, the most critical factor is that the patient eats.  Diet changes during times of illness are not a good idea, it is better to wait until they are feeling better then gradually introduce any new food.  It is best not to put medication in food as they can develop a food aversion or not recieve all their medication.

Sodium (Na) – There has been much discussion about low sodium diets in heart disease.  The current recommendation is

1. Asymptomatic heart disease (isachc 1a) – mild sodium restriction (less than 100 mg/100kcal)

2. Mild heart disease(isachc 1b) – less than 80 mg/100kcal

3. Moderate heart disease (isachc stage 2) – 50-80 mg/100kcal

4. Severe heart disease and congestive failure – less than 50 mg/100kcal

Protein – it is common for muscle wasting to occur as heart disease progresses.  This can be due to loss of appetite, increased energy requirement, increased production of inflammatory cytokines and “muscle-sparing” vascular shunting.  A high quality (very bioavailable) protein should be fed, unless there is concurrent kidney or liver failure.

Canine – 5.1g/100kcal and feline – 6.5 g/100kcal.

Fat – Most canine and feline diet contain primarily n-6 fatty acids.  Higher concentrations of N-3 fatty acids can be beneficial in reducing the production of cytokines and other inflammatory mediators.  Current dosing recommendations are 40 mg/kg of EPA (eicosapentoic acid) and 25 mg/kg of DHA.  Most capsules contain 180 mg of epa and 120 mg of DHA, so a dose of 1 capsule/10 pounds is used.  Fish oil supplements should always contain Vitamin E as an anti-oxidant, but not other nutrients to avoid toxicity.  Cod liver oil and flaxseed oil should not be used.

Supplements – Remember that dietary supplements do not require proof of safety, efficacy or quality control to be sold.  If used, careful selection of type and brand should be employed.  Regular cardiac medication or pharmaceuticals should always come first in terms of budget and administration.

Taurine – deficiencies of this can lead to dilated cardiomyopathy and were problematic in the 1980’s. The deficient diets have been corrected and this is less of a problem than before.  Measurement of plasma and whole blood taurine concentrations is considered in dogs with DCM in at-risk breeds such as cocker spaniels, newfoundlands, golden retrievers or dogs that eat lamb meal and rice-based diets, high-fiber diets, or highly protein restricted diets.  Supplementation at 500-1000 mg every 8-12 hours is current recommendation.

L-Carnitine– A family of boxers with dilated cardiomyopathy were found to be deficient from this in 1991. No blinded, prospective studies have been done in veterinary medicine at the time of this writing. A human study with DCM showed improved survival in patients recieving carnitine supplementation.  Canine dose is 50-100 mg/kg orally every 8 hours.

Low Sodium Treats

Reference – various writings, lectures by J. Rush, DVM, MS, DACVIM (cardiology), DACVEC and L. Freeman, DVM, PhD, DACVN

Miscellaneous Foods and sodium content

Margarine and Oil

Dairy Products

Meats, Poultry and Fish

Vegetables (fresh or dietetic canned)

Fresh fruits

Most are low in sodium and are permitted

Desserts